WQ0042507_Application (FTSE)_20210519

State of North Carolina
Department of Environmental Quality
NR Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number:(to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1.
Applicant's name: City of Wilson (company, municipality, HOA, utility, etc.)
2.
Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ® Municipal ❑ Other
3.
Signature authority's name: W.T. Bass IV, PE per 15,E NCAC 02T .0106(b
Title: Director of Public Works
4.
Applicant's mailing address: 1800 Herring Ave. E.
City: Wilson State: NC Zip: 27893-
5.
Applicant's contact information:
Phone number: [phone] Email Address: bbass aAwilsonnc.org
II. PROJECT INFORMATION:
a
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1.
Project name: Evolve at Heritage Phase 2-Public Outfall Sewer
2.
Application/Project status: ® Proposed (New Permit ❑Existing Permit/Project
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If a modification, provide the existing permit number. WQ00NeA and issued date: NIA
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If new construction but art of a master plan, provide the existing
p p g permit number: WQ000
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3.
County where project is located: Wilson
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4.
Approximate Coordinates (Decimal Degrees): Latitude: 35.747347' Longitude:-77.973835'
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5.
Parcel ID (if applicable): 3702-59-1073
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(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
l . Professional Engineer: Robert S. Bartlett License Number: 20106
Firm: Bartlett Engineering & Surveying, PC
Mailing address: 1906 Nash Street N.
City: Wilson State: NC Zip: 27893-
Phone number: [phone] Email Address. mberta,bartletteng.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Hominy Creek Water Reclamation Facility Permit Number: NCO023906
Owner Name: City of Wilson
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ0041572 Downstream (Receiving) Sewer Size: 12 inch
System Wi& Collection Svstem Permit Number(s) (if awlicab.le): WQCS
Owner Name(s):
FORM: FTA 04-16 Page] of5

V1. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑No ZWA
2. If the Applicant is a Developer of lots to be sold, has a Developer's C} eerational Agreement (FORM: DEV) been attached?
❑ Yes []No ®N/A
3. If the Applicant is a Homc Property.Owners' Association,, has an Qj2erational Agreement (FARM: HOA) been attached?
❑ Yes ❑No ®NIA
4. Origin of wastewater: (check all that apply):
❑ Residential Owned ❑ Retail (stores, centers, malls) ❑ Car Wash
® Residential Leased ❑ Retail with food preparation/service ❑ Hotel and/or Motels
❑ School / preschool / day care ❑ Medical / dental / veterinary facilities ❑ Swimming Pool /Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool/Filter Backwash
❑ Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: 100 % Domestic/Commercial ._ % Commercial
% Industrial See I SA NCAC 02T .0194201)
�Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .01 141f)? []Yes ❑ No
D It yes, vrovide a cowy of flow reduction Mproval letter
7. Summarize wastewater generated by project:
Establishment Type (see 021.0114{f))
Daily Design Flow
No. of Units
Flow
Residential Units
120 gal/room/day
96
11,520 GAD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gaV
Total
11,520 9GPD
a See 15A NCAC 02T .0114Ib1_ Ld),_(e)(Il and (e)f21 for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling; proposed unknown non-residential development uses; public access facilities Iocated near high public use areas;
and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in G.S. 42A-4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.01 141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 0 GAD (per 15A NCAC 02T .0114)
D Do not include future flows or previously permitted allocations
If permitted flow is zero, indicate why:
® Pump Station or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line
❑ Flow has already been allocated in Permit Number:
❑ Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other (Explain):
FORM: FTA 04-16 Page 2 of 5